I'm confused and wondering if any of our readers can shed some light on the following article. Seems to me, after reading the linked reports created by the good doctors who, along with our most helpful drug companies, determined that most of us need medication to help raise the "good" and bring down the "bad" cholesterol.

What Most Doctors Won't Tell You About Cholesterol
Posted By Dr. Ben Kim on Nov 20, 2008

* Healthy Eating Resources

Updated on November 20, 2008

During my university years, I used to frustrate my parents by throwing away egg yolks and eating only the whites. No worries, I thought, as my parents just didn't know enough to realize that I was reducing my risk of heart disease by avoiding cholesterol. Looking back, I'm sure that my parents were wondering how I could so easily toss away precious egg yolks that they were able afford only a few times a year when they lived in Korea.

Today, I am grateful to have a better understanding of the relationship between cholesterol and health. How about you? Are you afraid of having high cholesterol? Are you throwing away egg yolks because you think they're bad for your health? Are you taking cholesterol-lowering medication or considering starting on one?

If you answered yes to any of these questions, I encourage you to consider the work of Uffe Ravnskov, MD, PhD, author of The Cholesterol Myths : Exposing the Fallacy that Saturated Fat and Cholesterol Cause Heart Disease. I consider Dr. Ravnskov to be the world's leading expert on the relationship between cholesterol and human health.

Here are some facts from his book:

1. Cholesterol is not a deadly poison, but a substance that you need to be healthy. High cholesterol itself does not cause heart disease.
2. People who have low blood cholesterol have the same rates of heart disease as people who have high blood cholesterol.
3. The cholesterol found in your blood comes from two sources: cholesterol in food that you eat and cholesterol that your liver makes from other nutrients.

The amount of cholesterol that your liver produces varies according to how much cholesterol you eat. If you eat a lot of cholesterol, your liver produces less. If you don't eat much cholesterol, your liver produces more. This is why a low cholesterol diet does not typically decrease a person's blood cholesterol by more than a few percent.
4. Drugs that solely lower your cholesterol do not decrease your risk of dying from heart disease, nor do they increase your lifespan. These drugs pose dangers to your health and may decrease your lifespan.
5.The newer cholesterol-lowering drugs - called statins - do reduce your risk of heart disease, but through mechanisms that are not related to lower blood cholesterol. And alarmingly, statins like lipitor mevacor, zocor, pravachol, and lescol are known to stimulate cancer in rodents.

What about HDL and LDL?

Well, here are some facts about LDL and HDL that the vast majority of my patients are surprised to learn:

* LDL and HDL are not types of cholesterol.
* LDL and HDL are lipoproteins that transport cholesterol through your blood circulatory system.
* LDL stands for Low Density Lipoprotein, and HDL stands for High Density Lipoprotein.
* LDL is often mistakenly thought of as being bad cholesterol because it carries cholesterol to your arteries.
* HDL is often mistakenly referred to as good cholesterol because it carries cholesterol away from your arteries (to your liver).
*LDL and HDL carry the same cholesterol.

Here are the main points to take away from the facts presented above:

Cholesterol that naturally occurs in animal foods is not harmful to your health. But it can become harmful to your health if it is damaged by exposure to high levels of heat and/or harsh processing techniques.

If you regularly consume damaged cholesterol and foods that are rich in free radicals, you likely have significant quantities of damaged cholesterol floating through your circulatory system.

And if you regularly have damaged cholesterol floating around in your blood, then a high LDL level correlates with a higher-than-average risk of developing cardiovascular disease, and a high HDL level correlates with a lower-than-average risk of developing cardiovascular disease.

In other words, if you have significant amounts of damaged cholesterol in your blood circulation, you don’t want a lot of LDL to be available to carry this cholesterol to your arteries, where the damaged cholesterol can contribute to atherosclerosis, and you want a lot of HDL available to shuttle damaged cholesterol away from your arteries.

So while it’s true that a high HDL/total cholesterol ratio can reflect a lower risk of developing cardiovascular disease, what’s most important when it comes to cholesterol and your health is to avoid eating animal foods that have been cooked at high temperatures, since these foods are typically rich in damaged cholesterol.

Where Conventional Guidelines Come From

Sadly, conventional guidelines that promote lower cholesterol levels for a healthy heart are influenced in large part by pharmaceutical companies earning billions of dollars with their cholesterol-lowering drugs.

For example, in the summer of 2004, a panel of physicians lowered the “safe” level of LDL cholesterol from 130 to 100, and further recommended that people at high risk of developing cardiovascular disease aim to lower their LDL levels to 70.

This modification in medical standard of practice caused an estimated eight million Americans to become instant candidates for cholesterol-related drug therapy.

While this “news” was covered by major media outlets and news wires, only one newspaper, Newsday, reported that most of the physicians responsible for establishing the new recommendations had a conflict of interest. Almost all had received money – usually in the form of grants or honoraria – from at least ten drug companies. The National Cholesterol Educational Program, the source of the new medical treatment guidelines for cholesterol, failed to report these financial disclosures.

Guidelines for Healthy HDL, LDL, Total Cholesterol, and Triglyceride Levels

What follows are my personal guidelines on monitoring cholesterol, based on the research that I've done on this issue, and evaluating the blood test results and health of hundreds of people I have worked with over the past several years.

1. Ideally, it's best to have a blood cholesterol level of over 150 mg/dL (3.9 mmol/L). But if your blood cholesterol level is lower than this, so long as you are eating a nutrient-dense, plant-centered diet and not suffering from any health challenges, there is likely no cause for concern.

Low cholesterol over the long term may lead to depression, increased risk of stroke, and numerous problems related to hormonal imbalances. If you are not getting enough vitamin D from your diet, having low cholesterol may lead to vitamin D deficiency, as sunlight creates vitamin D in your body by acting on cholesterol found in your skin.
2.Ideally, your HDL/total cholesterol ratio should be above 25%. Generally, the higher this ratio, the better. If this ratio is 10-15 percent or lower, there increased risk of eventually experiencing a heart attack.
3. Ideally, it's best to have a triglyceride/HDL ratio of 2.0 or lower.
4. If your HDL/total cholesterol and triglyceride/HDL ratios are in the ranges listed above, and you are eating mainly undamaged cholesterol, having a total cholesterol of more than 200 mg/dL (5.2 mmol/L) most probably isn't a cause for worry. In fact, even people whose genetics cause them to have total cholesterol above 350 mg/dL (9.0 mmol/L) have been shown to have no elevated risk of heart disease as long as their ratios are fine and they stay away from eating damaged cholesterol.

Here's my take-home perspective on cholesterol and your health:

Rather than focus just on the numbers from your latest blood test, your health is best served by:

1.Ensuring regular intake of a wide variety of nutrient-dense plant foods (vegetables, legumes, fruits, whole grains, and small amounts of nuts and seeds).
2.Ensuring regular intake of healthy fats, such as those found in avocados, olives, coconuts, organic eggs, and perhaps some cold water fish on occasion.
3.Minimizing intake of animal foods that have been highly processed and/or exposed to high cooking temperatures.
4.Striving to live a balanced life that includes adequate rest, physical activity, exposure to fresh air and sunlight (without getting burned), meaningful relationships, and a sense of purpose.

Please note: Some organizations cite various studies that indicate that low-fat and low-cholesterol diets are healthier than diets that include generous amounts of healthy fats and undamaged cholesterol. The problem with these studies, as I see it, is that they don't make a distinction between damaged vs. undamaged fat and cholesterol. And this is an extremely important distinction; there's a huge difference between eating lightly cooked organic eggs vs. a well done steak several times a week for many years.

Wow... This is a mix of good information and nonsense. It has me scratching my head.

This is the kind of sensationalist article that you might find some willing, no-name MD to write for a Pop-Health magazine. You say a few controversial things that are half-truths and total distortions of fact, and grab the public's attention with your alarmist, rebel views. You'll get some folks eating out of your hand after the intro, and then maybe you tell them a few things that your grandmother could have told you. (eat your veggies, get rest, play in the sun, fish is good for you, etc.).

The controversy - to the extent there is one - is the point at which one should be taking Statins, and the desired dose. I listen to the debates in the literature as to where that bright line is or isn't.

There are a few truths. Had a heart attack, stroke, or TIA? Get on a statin.

Meanwhile... here are the points that your grandmother could have told you.

Olive oil and fat from nuts are good.

Fish is good. Uncooked fish is better. Properly processed fish oil is probably a good thing.

The sun and/or vitamin D are good.

Fruits and vegetables are good.

Stay away from processed and preserved food. The closer to Nature, the better.

Don't overcook your food.

Whole grains are good. Bleached anything (rice, pasta, etc.) and white (as opposed to sweet) potatoes are not as good. Modern twist - pay attention to the glycemic index.

Pay attention to the RATIO of LDL to HDL. You want the right balance of lipoproteins that carry cholesterol to and from their destinations.

Your cholesterol is a function of that which you eat and that which you manufacture. And the latter depends a lot on the amount of saturated and hydrogenated fats in your diet. Yes, egg yolks are a source of saturated fat. (The cholesterol isn't really the big problem.)

Heart disease and stroke are MULTIFACTORIAL diseases. It's the confluence of many things that puts you at risk - or not.

Not all cholesterol drugs are created equal. Only a handful of the classic statins have (so far) been shown actually to extend life - the bottom line distal outcome. The jury is still out on many new cholesterol drugs.

Get the right amount (and types) of exercise, and the right amount of sleep.

First things first. Kauai is awesome. I dunno if it affected my lipids. My thoughts:

"1. Cholesterol is not a deadly poison, but a substance that you need to be healthy. High cholesterol itself does not cause heart disease."

Cholesterol is essential for life, and too much is a bad thing. The same applies to myriad substances from water, metals like copper and iron, and electrolytes like sodium and potassium; the only difference is you can make your own cholesterol if you need some (as correctly noted in item 3).

"2. People who have low blood cholesterol have the same rates of heart disease as people who have high blood cholesterol."

A simplification, for one, and also false. Seriously... ten billion cardiologists are walking around mistakenly convinced that high cholesterol is a risk factor for atherosclerosis? Puhlease.

"4. Drugs that solely lower your cholesterol do not decrease your risk of dying from heart disease, nor do they increase your lifespan. These drugs pose dangers to your health and may decrease your lifespan."

"Drugs" is a vague term, but we know that statins are good for people with established atherosclerosis but do not decrease mortality in people without it.

"5.The newer cholesterol-lowering drugs - called statins - do reduce your risk of heart disease, but through mechanisms that are not related to lower blood cholesterol. And alarmingly, statins like lipitor mevacor, zocor, pravachol, and lescol are known to stimulate cancer in rodents."

Of course lowering cholesterol is related; it's true it's not the only effect. And from wiki: "Although there have been concerns that statins might increase cancer, several meta-analyses have found no relationship to cancer, the largest of which as of 2006 included nearly 87,000 participants.[38] However, in 2007 a meta-analysis of 23 statin treatment arms with 309,506 person-years of follow-up found that there was an inverse relationship between achieved LDL-cholesterol levels and rates of newly diagnosed cancer that the authors claim requires further investigation.[39]"

"* LDL is often mistakenly thought of as being bad cholesterol because it carries cholesterol to your arteries."

Well, this is actually true. Admittedly we can't live without LDL, but no one is discussing banning it. Apparently cells are happy getting cholesterol for their needs with a LDL blood level of around 50. The most aggressive targets we shoot for in the highest risk people are 80-100. Many other people run around 160+; that's clearly terrible for you.

"Damaged cholesterol" is a pretty vague concept. Maybe they mean oxidized, but it's worth pointing out that the conditions which lead to high cholesterol intakes and high sat fat intakes are the same ones that predispose to damaged oxidizing your lipids.

It's interesting that this individual doesn't mention the research he's "done on this issue." I checked pubmed and the ubiquitous kim name is not helpful--but kim b cholesterol searches to a number of articles (77) including this one:

which suggests that getting to LDL 70 is helpful. Nothing else suggests anything about being better off with a higher cholesterol. The 150 he cites as a goal is NOT a good idea. Diets like the Pritikin diet have been shown to lower risk of disease and cholesterol well below this value (as well as lower HDL--less garbage, less garbage trucks).

As for his advice, sure, nutrient dense plants is wise, health fat is wise (why he would minimize fish is a mystery to me; mercury?), minimizing animal fat, and a healthy lifestyle are all wise. The suggestion to avoid damaged cholesterol is not very helpful. Try to find that on a label (or in a paper!).

I will add that the sun causes cancer. Get your vitamin D from supplements instead--oh, and save the sun spots and wrinkles too. Other than that I agree with Bill.

"Drugs" is a vague term, but we know that statins are good for people with established atherosclerosis but do not decrease mortality in people without it.

I agree with Ian but disagree with the delivery system offered by conventional medicine to reduce cholesterol. Otto Warburg who did the original studies on the "bio-energetics" of the cell, namely the "mitochondria" basically stated that all disease comes from the breakdown of this cellular reactor which is what creates the energy for the cell...ATP. Free radical damage (from high sugar and simple carbohydrate diets) along with environmental pollution (heavy metal toxicity environmental toxins...etc.) are the real culprits for all disease in as much as they breakdown communication within the cellular matrix where all cellular communication takes place. Putting a "band-aid" on a deeper issue may offset bio-markers but does nothing to reduce or rejuvenate this mitochondrial breakdown which will offer true healing on a cellular, tissue and organ level.

If you are interested, a one year study directed by the Vietnamese Ministry of Health done in 2001 at the Cho Ray Hospital in Ho Chi Minh City on the efficacy of a rice based peptide which was given orally to hospital staff who showed HDL Cholesterol and Lipidema Disorders, just let me know. The results are pretty impressive. This study shows how changing mitochondrial function in the cell has dramatic effects.

This will be a good time to offer more consistent information on what therapies are available as an alternative to conventional pharmaceutical therapy. I just got back last weekend from the 13th Annual Conference on Bio-Energetic Medicine held in St. Petersburg, FL hosted by Daniel G. Clark, Md and Lee Cowden, MD who offered lecturers from around the globe who are utilizing IV Vitamin C therapy, Ozone Therapy, Insulin Potentiating Therapy and Nutirceuticals with extremely good results. The one common fact each presenter offered the attendees during the weeked was the fact that: The leading cause of death for people with cancer is conventional medical treatment...I am definately not making this one up folks. It even took me by surprise!

Just another aside...I was speaking to a Chiropractor friend of mine who's ex-wife is an attorney who stated the next legal battle against the pharmaceutical industry will be the lawsuites filed for people who have been physically damaged by statin drugs....I guess it has to get as bad a vioxx and cellebrex (75,000) deaths directly related to heart attacks and strokes in those taking these two anti-inflamatory medications before they were pulled off the market.

I agree with Ian but disagree with the delivery system offered by conventional medicine to reduce cholesterol.

Whenever I see language like this, a red flag goes up.

There is only one *meaningful* distinction in medicine - medicine that works (a.k.a. evidence-based medicine) and medicine that doesn't. Any other "us vs. them" labels are IMHO self-imposed and self-serving.

If I'm a betting man and/or someone who is going to put something in or on my body, the best source from which to make a good decision about what works and what doesn't is the peer-reviewed literature. That's where all ideas - the good, the bad, and the truly dangerous - get to see the disinfecting light of day, and are judged quite literally by a jury of professional peers. If ideas cannot make it past that jury and into reputable journals, then the situation speaks for itself. This is what patients as well as those who pay for care (the government, health insurers) use to protect themselves from hucksters who - at best - offer us therapies that don't work and waste our time and money. At worst, unproven therapies do harm and prey on the vulnerable.

saterraji wrote:

all disease comes from the breakdown of this cellular reactor which is what creates the energy for the cell...ATP.

Tell that to H1N1, which was responsible for the greatest epidemic in history and killed tens of millions of people before we discovered it and developed vaccines to prevent it from killing more people.

Mitochondria are vital to cell function. But it's just wrong to blame all disease on dysfunctional mitochondria.

saterraji wrote:

an attorney who stated the next legal battle against the pharmaceutical industry will be the lawsuites filed for people who have been physically damaged by statin drugs

It's called Sutton's Law. What's that, you ask? Willie Sutton was a bank robber. Once someone asked him why he robbed banks. His answer? "It's where the money is."

Look where there is money, and that's where you'll find the ambulance chasers sniffing for bucks and trolling on daytime television for trailer trash. There are people who make things for a living, and then there are people who try to get at the money made by people who are engaged in real work.

Don't get me started...

Another maxim here... NO (none, zero, nada) therapy is without a potential side effect. Every therapy offers a risk-benefit proposition. The good offered by the therapy should outweigh the potential risk, or it shouldn't be prescribed.

Statins are prescribed in large volumes because in many cases, it's evidence-based medicine. In other words, in the right situation for the right patients, they prevent bad events from happening (heart attacks, strokes) and they save lives. Exactly what all those myriad situations are is the subject of great debate in the peer-reviewed literature. And that is where the debate should be conducted. Meanwhile licensed MDs should be the ones interpreting that literature and deciding when that medicine is good for any given patient.

HOWEVER....

It is also true that diet and exercise work. That too is "evidence-based medicine." I started a list above of such therapies. If anyone wants to add to the list, by all means do. We've got a great forum here to put said recommendations to a little bit of our own peer review.

It's also worth mentioning (for truth in advertising) that:

I do not take a statin

I do not work for the pharmaceutical industry. I'm merely a PhD biomedical engineer who studies medicine by mining health care transaction data.

I have excellent cholesterol levels because I abide by my own recommendations above and I was blessed with good DNA. In fact I take no (zero, nada, zilch) daily medications except for some Zyrtec during allergy season. That ain't bad for someone my age; I must be doing something right. But then I am just one data point.

One final philosophical note... There is no evil in profit. That's what makes capitalism work, and why our health care system offers some of the best therapies available in the world. If someone provides a useful product or service, they deserve to make a good living doing that. The better the widget, the more profit they should get. Profit is only evil in socialist and communist governments.

Profit however IS the mother's milk of ambulance chasers. The "alternative medicine" group isn't going to be followed by a bus-load of trial lawyers because of Sutton's Law - that AIN'T where the money is. And that speaks for itself.

However..

If you live well and live wisely (per recommendations above) then in many cases you can "do it yourself." Any good health care practitioner will - or at least should - tell you that.

I agree with Bill (except that he gives MD's a little too much deference in reviewing the literature and making decisions in individuals--that's a good model but too often the decisions aren't wise, and I think it is quite appropriate for others to apply pressure to us MD's to improve our work).

Saterra, we do agree on one huge point, which is that it's better to deal with the underlying problem than slap on a bandaid. If a patient has diabetes and high cholesterol, then yes, of course, the best course is to eat a perfect and reduced calorie diet, lose weight, improve insulin sensitivity, get that extra cholesterol removed from vessels and metabolized, etc. BUT that may not be enough and honestly most Americans won't do it. Why do you think we have an obesity and diabetes epidemic in the first place?

At that point, we need drugs to help. IMNSHO, the distinction between supposedly evil, dangerous, money driven, doctor prescribed chemicals and natural solutions is completely nuts. Statins are a great case in point. Statins are a natural solution. They first came from red yeast extract, a chinese herbal preparation. THAT stuff has lots of other potentially toxic, hard to quantify and dose, variable components and has an INCREASED myopathy and side effect risk. Purifying the best parts and quantifying their benefits AND RISKS has been tremendously helpful, but many people irrationally prefer the "natural solution," which is quite literally like eating spoiled yeasty foods to get some amount of penicillin and skipping the conveniently standardized and studied capsule option. The natural stuff may seem safer, but may not do anything, and is probably only safer because the risks are simply not known yet. HAD the stuff been adequately tested, the risks would be known, and it would be an evil capitalistic product rather than a thing of nature anymore.

As for your comments on the rice peptide and the nutriceutical conference, by all means, please post some actual studies or data* we can talk about. I am always eager to learn new stuff. I am of course skeptical that conventional therapy is the leading killer of cancer patients, taking care of hundreds of them and seeing them virtually always die of their disease or another cause (or get better!). One thing to point out here is that medicines can be a victim of their own success. A major problem in AIDS care is long term side effects of the anti-HIV medications like lipodystrophy, hypertension, cholesterol, nerve damage, etc. And why are they having those problems? BECAUSE THEY DIDN'T RAPIDLY DIE OF AIDS LIKE THEY WOULD HAVE OFF THERAPY, AND THEY LIVED SO LONG AIDS ISN'T THEIR BIGGEST PROBLEM.

*as a starting point, consider your first paragraph. You assert that mitochondrial damage causes all disease, but promptly change direction and blame intracellular communication. In other words, you don't believe you. And as Bill has pointed out, of course there are infectious diseases, and I would point out obvious genetic disease and more subtle inherited predispositions, autoimmune disease, wear and tear illness, spontaneous cancers, and so on. Blanket statements are far too squishy to provide a foundation for a real discussion.

This is the stuff that retrieves garbage from the periphery and returns it to the liver for reprocessing. High levels are protective from disease. However, you don't have to have a high cholesterol for a good risk profile, if you don't have much garbage to retrieve. Thus it matters more for an obese diabetic with high LDL and triglycerides than for a slender, lean, fit, insulin sensitive person with controlled LDL.

It's worth pointing out that lowering your cholesterol 15% by exercise and statins and zetia are different animals. Exercise conditions your heart; the others don't. It will make your muscles respond to insulin better and that's good for may things including components of the metabolic syndrome. Statins have many effects, as they turn off an enzyme that controls several things, not just LDL. Zetia only reduces absorption and has not ever been shown to produce a useful clinical outcome, just lower LDL.

Some people believe we focus too much on LDL levels rather than whether people get on a statin for heart disease regardless of level, and of course diet and exercise are wise whether you are lean or obese. Or normal weight obese.

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